Provider Demographics
NPI:1295234474
Name:LEON, CHRISTA JEAN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:JEAN
Last Name:LEON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:MCDIFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:5859 W TALAVI BLVD STE 180
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1873
Practice Address - Country:US
Practice Address - Phone:602-560-2836
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000780103K00000X
CA1625353106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-46684OtherBCBA CERTIFICATE